【摘要】 目的采用Meta分析的方法比较关节镜下单排缝合与双排缝合治疗肩袖撕裂的临床疗效。方法计算机检索Scopus、Pubmed、Medline和Cochrane数据库,选择比较关节镜下单排缝合与双排缝合治疗肩袖撕裂临床疗效的随机对照研究,依照Cochrane系统评价方法进行质量评价后,对纳入研究进行资料提取,采用Rev Man 5.1软件进行Meta分析,并使用GRADE系统评价证据质量和推荐等级。结果纳入文献7篇。从临床评分看,在术后≤1年的Constant评分(WMD=-3.40,P>0.05)、ASES评分(WMD=0.98,P>0.05)、UCLA评分(P>0.05)以及术后≥2年的Constant评分(WMD=0.82,P>0.05)、ASES评分(WMD=0.64,P>0.05)上,单排组与双排组差异无统计学意义,但术后≥2年的UCLA评分(WMD=0.59,P<0.01)双排组占优;对大小≤3 cm的撕裂,术后Constant评分(P>0.05)、ASES评分(WMD=0.19,P>0.05)、UCLA评分(WMD=0.44,P>0.05)差异无统计学意义,对大小≥3 cm的撕裂,术后Constant评分(P>0.05)差异无统计学意义,而术后ASES评分(WMD=1.45,P<0.05)、UCLA评分(WMD=0.63,P<0.01)双排组占优。从肩关节肌力看(WMD=-0.15,P>0.05),两组术后无统计学差异。从关节活动度看,双排组在前屈(WMD=5.41,P<0.01)、外展(WMD=5.65,P<0.01)方面优于排,但两组在内旋(WMD=0.89,P>0.05)、外旋(WMD=0.36,P>0.05)方面差异无统计学意义。双排组的术后肩袖愈合率(RR=1.20,P<0.01)高于单排组,单排组的术后部分愈合率(RR=0.53,P<0.05)高于双排组,但两组在术后再撕裂率(RR=0.81,P>0.05)方面差异无统计学意义。基于GRADE系统的证据推荐等级评价结果显示:单排组与双排组比较,肩袖愈合率的证据水平为低,推荐意见为弱推荐;部分愈合率的证据水平为低,推荐意见为弱推荐;再撕裂率的证据水平为中,推荐意见为弱推荐。结论双排缝合技术能部分改善肩袖撕裂患者术后肩关节功能,尤其对大小≥3 cm的撕裂,双排缝合技术虽然术后肩袖愈合率较高,但并不能降低术后再撕裂率。上述结论需要更多高质量大样本RCT加以验证。更多还原

【Abstract】 Objective To compare the clinical outcomes of arthroscopic rotator cuff repair of single-row versus double-row fixations with meta-analysis. Methods The databases including Scopus,Pubmed,Medline and Cochrane were searched to collect the randomized controlled trials( RCTs) which compared arthroscopic single-row versus double-row repairs. According to the inclusion and exclusion criteria,data of the included studies were extracted,and the methodological quality was evaluated by Cochrane Handbook. The meta-analysis was performed using Rev Man 5. 1,and the evidence qualities and recommendation levels were determined according to the GRADE System. Results A total of seven RCTs were included. In the light of the clinical scales,the differences in the short-term Constant score( WMD =- 3. 40,P > 0. 05),ASES( WMD = 0. 98,P > 0. 05),and UCLA( P > 0. 05),as well as the long-term Constant score( WMD = 0. 82,P > 0. 05) and ASES( WMD = 0. 64,P > 0. 05) were not significant between the two groups. However,the long-term UCLA( WMD = 0. 59,P < 0. 01) was significantly higher in the double-row group. As for the cases with the tear size smaller than 3 cm,the differences in Constant score( P > 0. 05),ASES( WMD = 0. 19,P > 0. 05) and UCLA( WMD = 0. 44,P > 0. 05) between the two groups were not significant. In the cases with the tear size larger than 3 cm,the difference of Constant score( P > 0. 05) was not significant,but the values of ASES( WMD = 1. 45,P < 0. 05) and UCLA( WMD = 0. 63,P < 0. 01) were markedly higher in the double-row group. The difference in muscle force( WMD =- 0. 15,P > 0. 05) between the two group was not significant. Comparing the range of motion after surgery,the double-row group showed superior results in flexion( WMD = 5. 41,P < 0. 01) and abduction( WMD = 5. 65,P < 0. 01),but not significantly better in internal rotation( WMD = 0. 89,P >0. 05) or external rotation( WMD = 0. 36,P > 0. 05). The integrity of the rotator cuff( RR = 1. 20,P <0. 01) was better but the partial healing rate( RR = 0. 53,P < 0. 05) was lower in the double-row group.The full-thickness retear rate( RR = 0. 81,P > 0. 05) showed no difference between the two groups. Based on the GRADE system,the evidence level of the integrity of the rotator cuff was low with a weak recommendation; the evidence level of partial healing was low with a weak recommendation; the evidence level of full-thickness retear was moderate with a weak recommendation. Conclusion The Meta-analysis suggests that the double-row repair improves postoperative clinical outcomes in some way and increases the rotator cuff healing rate especially for the tears larger than 3 cm,but the full-thickness retear rate does not decrease. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.更多还原